Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Email Address:

We never sell or give out your contact information.
We respect our readers' privacy.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When Healthcare.gov ran into problems we heard all about the health insurance exchanges (HIX). Since Healthcare.gov hasn’t run into any issues we aren’t hearing about health insurance exchanges nearly as much. The exception might be the states that were running their own HIX and failed. I’ve seen a number of those stories out there.

However, I think that the HIXs have largely left the healthcare dialogue in general. I’m sure the payors involved in the exchanges are still highly involved, but most people aren’t following it.

This was driven home to me when I saw the following two tweets and images about HIXs.

I’ll admit that I haven’t dug into the exchanges lately either other than when I tried them out at the end of last year when I had to find a new insurance company (Side note: the price on the HIX was more than what I could get separate and they weren’t offering me a subsidy, so I didn’t end up using the HIX). Since I haven’t been involved or watched what’s happening with HIXs, I can’t say if they’re a good or a bad thing. What I do know is that they’re playing a huge role in healthcare and how and what health insurance people are getting. So, maybe we should be paying more attention.

Maybe some of my readers are following it a lot closer than I am doing. If you are, please enlighten us in the comments.

One response to "Have We Forgotten About Health Insurance Exchanges (HIX)?"

In New York, there is now a fair variety of options on the exchange. However, to get that far one needs to go through the INCOME questions, where IMHO are very poorly documented and explained, often leading to surprise results on any credits.

Once you get through that mess, the selection site pops up and works fairly well, but it can be difficult to make valid comparisons. But nothing warns you in particular that New York State made some odd choices for the rules for their plans; 1. you are limited to a single prosthesis (they based that rule off one of the worst plans ever offered in NYS), and 2. no out of plan coverage in any plan at all – again, some odd decision by unnamed officials.

Weeks after I had selected 2015 coverage, I suddenly discovered that my employer had made me eligible for their coverage. I found that my employer paid (including my portion) about the same I was paying on my own (including any credits I might have gotten), yet the coverage, through a corporate exchange, was noticeably better in NOT requiring any referrals, and having a noticeably smaller maximum out of pocket, and more providers in plan.

I found that rather odd, at least on the surface. Sure, my employer has overall a fairly large risk group – and it may be part of a multi employer exchange. And it is not limited to a single county – which would make it very small. The state’s groups seem to be kept artificially small by limiting them to a single county or group of counties in a region (like Long Island with its 2 non-NYC counties). It makes you wonder what other things individual states do that force up coverage cost while forcing down quality of coverage. Presumably this comes from heavy lobbying from insurance companies. Presumably NYS could force larger risk groups by widening the coverage areas. I’m also guessing that forcing state and local employees into these plans would also enlarge the risk groups and make for an overall better choice of plans, especially with pressure from unions.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

Email Address:

We never sell or give out your contact information. We respect our readers' privacy.